华西医学

华西医学

颈椎动态稳定器置入术治疗单节段退变性颈椎间盘突出症的中期疗效观察

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目的探讨使用颈椎动态稳定器(dynamic cervical implant,DCI)置入术治疗退变性颈椎间盘突出症的中期疗效。方法2010 年 4 月—2011 年 6 月,应用 DCI 置入术治疗单节段退变性颈椎间盘突出症患者 25 例。采用疼痛视觉模拟评分(Visual Analogue Scale,VAS)、颈椎残障功能指数(Neck Disability Index,NDI)评分、日本骨科协会(Japanese Orthopaedic Association,JOA)评分及 36 项简明健康调查问卷(36-Item Short Form Health Survey Questionnaire,SF-36)随访评价生活质量、颈脊髓功能情况。术后随访观察颈椎整体活动度、DCI 手术节段、相邻节段活动度、手术节段椎间隙高度、假体下沉、移位、手术节段异位骨化等情况。结果25 例患者随访时间 68~78 个月,平均 72.3 个月。VAS 评分、JOA 评分、NDI 评分、SF-36 评分术后均较术前明显改善,在随访过程中得到了很好的维持。DCI 置入节段活动度在术后 2 年内得到较好保持,但末次随访时明显下降(P<0.05);C2–7 活动度及手术邻近节段活动度末次随访与术前及术后各次随访差异均无统计学意义(P>0.05)。手术节段椎间高度在术后 2 年内维持良好,然而末次随访时明显下降(P<0.05)。末次随访时,44.0%(11 个)的 DCI 假体出现了下沉,36.0%(9 例)出现置入节段异位骨化。结论应用 DCI 置入术治疗退变性颈椎间盘突出症的中期随访临床症状改善满意,但手术节段活动度丢失明显,假体下沉和手术节段的异位骨化发生率较高,存在神经症状复发和邻近节段退变的风险,不能作为单节段退变性颈椎间盘突出症的首选手术方式。

ObjectiveTo evaluate the mid-term clinical and radiological results of dynamic cervical implant (DCI) arthroplasty for degenerative cervical disc disease in Chinese population.MethodsBetween April 2010 and June 2011, 25 patients with single-segmental degenerative cervical disc disease underwent DCI replacement. Visual Analogue Scale (VAS), Japanese Orthopaedic Association (JOA) scores, Neck Disability Index (NDI) and 36-Item Short Form Health Survey Questionnaires (SF-36) were used for evaluation of neurological function and pain severity, before and after operation, and during follow-up period. Radiographic evaluation included range of motion (ROM) of C2–7, surgical segments and adjacent level, intervertebral height of the surgical segments, migration, subsidence of the implant and heterotopic ossification (HO).ResultsThe mean follow-up period was 72.3 months (ranged from 68 to 78 months). The VAS, JOA, NDI, and SF-36 mental and physical component summaries improved significantly after surgery (P<0.05) and remained stable over the whole observation period. The ROM (flexion/extension) and intervertebral height at the level treated with DCI remained at the first 2 years and partly reduced at the final follow-up. ROM for C2–7 and adjacent levels maintained during the follow-up period. DCI subsidence was observed in 11 segements, and 9 segements appeared heterotopic ossification.ConclusionsClinical efficacy of DCI arthroplasty improves and maintaines during the mid-to-long period of follow-up. HO formation is a common phenomenon, leading a dramatic decrease of ROM at index level and recurrence of neurological symptoms. Rate of implant subsidence and migration is relatively high, leaving a potential risk of symptom at index level and adjacent segment degeneration. It suggests that for patients with degenerative cervical disc disease, total disc replacement or anterior cervical discectomy and fusion is still the first choice instead of DCI arthroplasty.

关键词: 颈椎; 颈椎动态稳定器; 治疗结果; 下沉; 异位骨化

Key words: Cervical vertebrae; Dynamic cervical implant; Treatment outcome; Subsidence; Heterotopic ossification

引用本文: 王林楠, 汪雷, 宋跃明, 刘立岷, 杨曦, 丰干均, 周春光. 颈椎动态稳定器置入术治疗单节段退变性颈椎间盘突出症的中期疗效观察. 华西医学, 2018, 33(9): 1073-1078. doi: 10.7507/1002-0179.201802008 复制

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